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ANAHEIM, Calif.—The “fixes” to today’s health care (and more specifically cancer care) dilemmas will require more coordination of care, and more individuals to act as navigators to help guide patients through the maze of care regulation, insurance red tape, hospital care, and specialty care — so explained the Oncology Nursing Society’s Health Policy Director, Alec Stone, MA, during a session on health policy issues here at the ONS Annual Congress.

“Almost all successful models of care coordination have incorporated patient-based communication,” he said. “You as nurses — you have the central role here.”

During the session Stone talked about H.R. 1661, legislation that would amend title XVIII of the Social Security Act to provide (paid) comprehensive cancer patient treatment education under the Medicare program. In an interview after the session, Stone reiterated these key points about what the proposed law would change, and how oncology nurses can play a role in getting the bill passed.

“The legislation calls for one hour of one-on-one reimbursed time [$83/hour] to educate cancer patients in an outpatient practice about their symptom management. And that hour of education would be reimbursed by Medicare.

“The idea is that that one hour of education gives the patient an understanding of what their disease is and what the symptoms are, so they can take better care of themselves — and would diminish hospital readmissions — and diminish the need for patients to run to use the emergency room as a primary care physician. An ounce of prevention saves millions of dollars down the road.”

2. And the idea is that once Medicare does it, private insurers will follow suit?

“It’s not immediate — it takes time. But people come to demand it.

“It’s already happening in diabetes. Diabetes educators get $45 for 30 minutes of patient education [reimbursed by Medicare] to teach the patient about how to manage blood sugar levels and how to use insulin, and appropriate nutrition and exercise programs.

“And insurance companies now are not suggesting that diabetics get this education, they are demanding that they get it — because when a patient’s disease is out of whack, it costs more. Now they’re saying it’s much cheaper for us, as the insurance company, to pay the $45 [for that hour of education], than for the patient to come in once a month or once a year [with complications].

”That’s what we’re saying for cancer as well — at the beginning, educate the patient, and later on you don’t have to pay for these other complications.”

3. What’s the next step to get the bill passed?

“Send letters and emails to your elected officials — members of Congress, your representatives and your senators. Educate your legislators. Here’s our bill, 1661. Either, ‘You’re not signed onto it, please sign onto it. I’m an oncology nurse and here’s what I think.’ Or, ‘You are signed onto this. Here’s what I just heard about this. Thank you very much.’

“If a U.S. Representative gets ten emails from ten oncology nurses, someone in that office is going to see that as a red flag. It’s not just one. Ten oncology nurses from one congressional district emailed us. Something is going on. We need to find out what that is.

“Oncology nurses are very powerful advocates and they have very powerful stories — about children with leukemia, about a wife with breast cancer, about a father with colon cancer. These are stories that resonate. They can really move audiences.

“It’s an uphill climb, though. We have 41 bipartisan cosponsors in the House, but we don’t have a companion bill in the Senate. So we’re working to energize our members to reach out to their senators to try to get a bill introduced.”

Sarah DiGiulioThe “3 Questions on…” blog asks oncology’s thought leaders for their perspectives and takes on the field’s current news and controversies. Want to get answers to your questions? Add a comment or email Pam Tarapchak at pam.tarapchak@wolterskluwer.com or Catlin Nalley at catlin.nalley@wolterskluwer.com to suggest a topic for a future column. We want to hear from you!